Shadows, Sundowning, and Full Moons

July 13, 2015

Shadows Deutsche Fotothek

My family listened to a lot of radio when I was growing up pre-television. I’m dating myself when I write that, at about the age of eight, one of my favorite radio dramas was The Shadow. It both frightened and fascinated me!

When the show’s eerie musical theme started, I would hide behind our living room sofa. The voice of actor Frank Readick Jr. mesmerized me. He announced with a spooky laugh, “Who knows what evil lurks in the hearts of men?” I guess at that age I thought the sofa would protect me from the “Shadow” popping out of the radio to grab me! Each episode would end with, “The weed of crime bears bitter fruit. Crime does not pay…The Shadow knows!”

A child’s imagination is one thing, but shadows, darkness, and perhaps even full moons can pose a problem and cause distress to a loved one with Alzheimer’s or dementia. Seeing shadows in the home, especially when there is poor lighting, and when it is later in the day, can bring on sundowning. Sundowning is a condition that occurs usually in the late afternoon or early evening. The Alzheimer’s Association defines it as “a syndrome characterized by cycles of increased confusion, anxiety, agitation, pacing and disorientation that affects people in moderate to late stages of dementia.” Simply put, as the sun goes down, your loved one may become more confused and irritable. The causes of sundowning are not yet fully understood. There are several theories about what causes it.

Some professionals attribute sundowning to brain fatigue. Your loved one’s brain has been working extra hard throughout the day to navigate their environment, trying to figure out what to do next. At some point, it may be that the brain has a “melt down.” This can lead to emotional outbursts.

Another theory concerns the presence of high levels of an enzyme in the brain. Researchers at Ohio State are running tests with mice. Their hypothesis is that there is a biological basis to sundowning. They are looking at a certain enzyme, acetylcholinesterase. This is present in high levels when aged mice display distress.

A third theory is that reduced light from the sun in the late afternoon and increased shadows may cause your loved one to misinterpret what they see. They become afraid or confused. Remember, their brains are working and processing information differently from yours.

A fourth theory says sundowning is related to changes or disruptions of the body’s internal clock and the sleep-wake cycle.

Because a person becomes agitated in the late afternoon or early evening doesn’t necessarily mean that they are sundowning. With sundowning, there is usually a pattern of behavior and repetition at the same time of day.

Some persons with dementia display agitation and start pacing. It becomes difficult for them to differentiate reality from past memories. This condition happened to my Mom when she was in the mid-stages of the disease.

I’ll never forget one of my visits to see her at the assisted living facility where she lived. My usual visits with her were in the morning, but that day I came to visit around 4 PM. Mom was pacing anxiously up and down the corridor of the assisted living unit. She didn’t even stop to say hello to me, as I tried to keep up with her. I asked her if we could sit down to visit. She swatted at me, and told me she needed to get home quickly before “…the kids come home from school, or mother will be mad at me.” It took me awhile to realize that she was reliving childhood memories. She was the second oldest daughter in a family of six children. One of her chores was to care for her four younger brothers after school, while her folks worked at their grocery store until supper time. This was the time of day when she would have left high school to attend to her brothers at home.

I told her that she didn’t need to worry, that her mother was still at the grocery store, and the kids had after school activities and so were running late. She called me a liar. I told her we would call her mother to make sure she knew the kids would be safe. Mom gave me a quizzical look at first and then calmed down. I told her we would go to her room to make the call. Once we got there, I tried to distract her by talking about something else. Fortunately, she seemed to have forgotten why we went to her room. I didn’t have to “fake” a phone call. We visited for awhile before it was time for her to go to supper. I walked Mom to her dining area and said goodbye. Since she had calmed down, I felt comfortable ending my visit and leaving her to go home.

Bluemoon by Craig Deakin UK

Do you find more intense behaviors in your loved one at the onset of a full moon? I recently spoke to a dear friend who cared for her mother-in-law who had Alzheimer’s. She told me that whenever there was a full moon, the staff at the nursing home would call in extra help. They knew that during the time leading up to a full moon, behavior in many of their residents with dementia would escalate.

I tried to research this full moon phenomenon. I never really noticed it in my mother’s behavior. I did find mention on Google of a researcher, Alan M. Beck of Purdue University. He conducted a longitudinal study of the influence of the moon on the intensity of behaviors in persons with AD. These behaviors were: wandering, anxiety, physical aggression, and verbal confrontation. His study concluded that persons with Alzheimer’s “…did exhibit significantly more behaviors during periods of full moon,” and the behaviors were of greater duration when the moon was full. I could not discover any more about this study. However, the next full moons in 2015 are: July 31 (a blue moon,) August 29, September 27, October 27, November 25, and December 11.

If your loved one displays dramatic changes in behavior at certain time of the day or month, there are a few things you can do to help cope with the situation and to calm your loved one. These involve experimenting in behavioral ways, as well as finding what in the environment might be causing the agitation.

First, keep a journal marking the time and conditions when this behavior happens. Try to find a pattern to what might be the cause of their behavior.

Second, think about your home. How is the lighting during those times when the sundowning begins? Are the rooms well lit? Putting lights on dimmers may help save electricity, while giving off enough light as the day gets darker. One suggestion I’ve read is to provide exposure to light (artificial or natural) in the early morning hours, from 6 AM to 9 AM. This might help set their “internal clock.”

Third, is this a time of day when activity in your house gets a little more hectic than usual? Are family members coming home from work, or kids returning from school? Is traffic noisier? Try to create a calm environment with fewer distractions. Playing soothing music or nature sounds like waves rolling onto the seashore or birds singing can have a calming effect.

Fourth, try to engage your loved one in a relaxing activity. It might help to look at photographs, work on something that they enjoy doing, or just take them for a short walk in your garden or yard, if they need to pace back and forth. Put on a DVD of beautiful photos and pictures for them to watch. (I feature a product offered by the AlzStore. It is a DVD called “Ambient Art.” It transforms your TV into an Impressionist art gallery. I have provided a link at the end of this article. The AlzStore also offers two DVD’s of virtual aquariums. One even has the choice of soothing bubbling sound effects or relaxing music in the background.)

Fifth, make sure your loved one is not thirsty or dehydrated, or needs to use the bathroom. They may not be able to ask you for a drink of water, or tell you they have to go to the toilet. Avoid caffeinated drinks after lunch.

Lastly, try to keep a regular daily schedule, as much as possible. If your loved one rests most of the day, they are likely to be restless at night. Plan regular daily exercise and meaningful activities. Try to keep outings and doctor appointments for the morning hours when they are more rested and better able to cope with the changes in surroundings.

If you have discovered something that works for your loved one in regards to sundowning, let me know. Just e-mail me a brief message (Vicki@caregiverfamilies.com). I’d be happy to share suggestions in a future blog.

I wish you peace, patience, and courage in your caregiving journey!

RESOURCES on SUNDOWNING

Here are two brief “YouTube” videos about sundowning: One is produced by the UCLA Alzheimer’s and Dementia Care Program: (https://youtu.be/kskiEKghjAE).

Just for fun and relaxation, listen to Camille Saint-Saens’ Opus 31, “Omphale’s Spinning Wheel.” When you get about three minutes into the piece, this part was used for the theme of The Shadow radio drama: (https://youtu.be/96aapx3DFdM)